肥胖儿童血清25-羟基维生素D和骨密度水平的变化及临床价值

Changes of serum 25-hydroxyvitamin D and bone mineral density in obese children and clinical value

目的探讨肥胖儿童与正常儿童25-羟基维生素D〔25(OH)D〕与骨密度的差异,分析肥胖与25(OH)D缺乏的关系。方法分析2019年12月—2020年8月湖南省儿童医院体检中心100名学龄期儿童的体检结果,以其中59名超重和肥胖儿童作为肥胖组,其余41名体质量正常儿童作为对照组。收集两组临床资料,采用酶联免疫吸附试验(ELISA)测定儿童血清25(OH)D,使用超声骨密度仪测定肱骨骨密度。采用Pearson相关分析法分析25(OH)D与体质量指数标准差得分(BMISDS)、腰臀比、胰岛素、骨密度、甲状旁腺激素(PTH)的相关性。结果肥胖组儿童身高、体质量、体质量指数(BMI)、BMISDS、腰围、腰臀比均明显高于对照组〔身高(cm):140.99±8.79比134.59±10.13,体质量(kg):51.14±15.96比28.06±6.00,BMI(kg/m2):25.14±4.02比15.56±1.51,BMISDS:2.89±0.97比-0.44±0.80,腰围(cm):89.95±12.44比58.99±6.24,腰臀比:0.98±0.08比0.85±0.05,均P<0.05〕,血清25(OH)D和骨密度均明显低于对照组〔25(OH)D(nmol/L):45.40±11.86比59.56±16.08,骨密度(g/m2):2.91±1.68比3.75±1.15,均P<0.05〕,胰岛素明显高于对照组(μg/L:25.57±7.98比14.03±3.00,P<0.05);两组PTH比较差异无统计学意义。血清25(OH)D水平与BMISDS、腰臀比、腰围呈负相关(r值分别为-0.996、-0.999、-0.467,P值分别为0.000、0.001、0.000),而与胰岛素、PTH、骨密度无明显相关性。结论肥胖儿童25(OH)D和骨密度水平均较正常儿童低,血清25(OH)D水平与肥胖具有相关性。

Objective To explore the differences between 25-hydroxyvitamin D[25(OH)D]and bone mineral density between obese and normal children,and analyze the relationship between obesity and 25(OH)D deficiency.Methods The test results of 100 school-age children in physical examination center of Hunan Children's Hospital from December 2019 to August 2020 were analyzed,including 59 overweight and obese children as obesity group and 41 children with normal weight as control group.The clinical data of two groups were collected,serum 25(OH)D was measured by enzyme linked immunosorbent assay(ELISA)and bone mineral density was measured by ultrasonic bone densitometer.Pearson correlation analysis was used to analyze the correlation between 25(OH)D and body mass index standard deviation score(BMISDS),waist to hip ratio,insulin,bone mineral density and parathyroid hormone(PTH).Results The height,weight,body mass index(BMI),BMISDS,waist circumference and waist to hip ratio of the obesity group were higher than those in control group[height(cm):140.99±8.79 vs.134.59±10.13,weight(kg):51.14±15.96 vs.28.06±6.00,BMI(kg/m2):25.14±4.02 vs.15.56±1.51,BMISDS:2.89±0.97 vs.-0.44±0.80,waist circumference(cm):89.95±12.44 vs.58.99±6.24,waist to hip ratio:0.98±0.08 vs.0.85±0.05,all P<0.05],the serum 25(OH)D and bone mineral density were lower than those in control group[25(OH)D(nmol/L):45.40±11.86 vs.59.56±16.08,bone mineral density(g/m2):2.91±1.68 vs.3.75±1.15,both P<0.05],and the level of insulin was higher than that in control group(μg/L:25.57±7.98 vs.14.03±3.00,P<0.05).There was no significant difference in PTH level between the two groups.Serum 25(OH)D was negatively correlated with BMI,waist circumference and waist to hip ratio(r values were-0.996,-0.999,-0.467,P values were 0.000,0.001,0.000).There was no significant correlation with serum insulin,PTH and bone mineral density(all P>0.05).Conclusion The 25(OH)D and bone mineral density in obese children were lower than those in children with normal weight.Serum 25(OH)D levels were correlated with obesity.